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Historically, did Cemented Thompson perform better than uncemented Austin Moore hemiarthroplasty for femoral neck fractures? A meta-analysis of available evidence.

ABSTRACT: INTRODUCTION:Thompson and Austin Moore prostheses have been commonly used in hemiarthroplasties for displaced femoral neck fractures. There has been considerable debate about which of these prostheses is preferred. The purpose of this meta-analysis was to compare historical data for clinical outcomes of cemented Thompson and uncemented Austin Moore hemiarthroplasty in displaced femoral neck fractures. METHODS:We searched Medline via PubMed, Cochrane Central, Scopus, Ovid and Web of Science for relevant articles up to February 2019. The included outcomes measured were hip function, hip pain, implant-related complications, surgical complications, reoperation rate and hospital stay. The data were pooled as risk ratio (RR) or mean difference (MD) with 95% confidence interval (CI) between the two compared groups in a meta-analysis model. RESULTS:Ten studies (four RCTs and six observational studies) with a total of 4378 patients were included in the final analysis. The pooled RR showed that the Thompson group was associated with a lower incidence of postoperative hip pain (RR = 0.66, 95% CI [0.54, 0.80]), lesser reoperation rate (RR = 0.46, 95% CI [0.24, 0.88]), lesser intraoperative fractures (RR = 0.15, 95% CI [0.09, 0.25]), but a longer operative time (MD = 12.04 min, 95% CI [2.08, 22.00]) in comparison to the Austin Moore group. The effect estimate did not favour either group in terms of hip function, periprosthetic fractures, prosthetic dislocations, wound infection, mortality and hospital stay. CONCLUSION:Evidence shows that Thompson hemiarthroplasty is better than Austin Moore hemiarthroplasty in terms of hip pain, reoperation rate and intraoperative fractures. Whereas the postoperative hip function is equivalent, these results could be considered when assessing the outcomes in modern hips.

SUBMITTER: Shehata MSA

PROVIDER: S-EPMC6753858 | biostudies-other | 2019

REPOSITORIES: biostudies-other

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Historically, did Cemented Thompson perform better than uncemented Austin Moore hemiarthroplasty for femoral neck fractures? A meta-analysis of available evidence.

Shehata Mohamed S A MSA Abdelal Ahmed A Salahia Sami S Ahmed Hussien H Shawqi Muhammad M Elsehili Ahmed A Morsi Mahmoud M Afifi Ahmed M AM Kader Nardeen N Grubhofer Florian F Sallam Asser A Imam Mohamed M

SICOT-J 20190906

<h4>Introduction</h4>Thompson and Austin Moore prostheses have been commonly used in hemiarthroplasties for displaced femoral neck fractures. There has been considerable debate about which of these prostheses is preferred. The purpose of this meta-analysis was to compare historical data for clinical outcomes of cemented Thompson and uncemented Austin Moore hemiarthroplasty in displaced femoral neck fractures.<h4>Methods</h4>We searched Medline via PubMed, Cochrane Central, Scopus, Ovid and Web o ...[more]

PMID: 31538934

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Project description:BackgroundThe purpose of our study is to assess the methodology of overlapping systematic reviews related to cemented vs uncemented hip hemiarthroplasties for the treatment of femoral neck fractures to find the study with the best evidence. Also, we assess the gaps in methodology and information to help with direction of future studies.MethodsA systematic search was conducted in September 2022 using Pubmed, Embase, and Cochrane Library. Clinical outcome data and characteristics of each study were extracted to see which treatment had better favorability. The outcomes and characteristics extracted from each study includes, first author, search date, publication journal and date, number of studies included, databases, level of evidence, software used, subgroup analyses that were conducted, and heterogeneity with the use of I2 statistics Methodological quality information was extracted from each study using four different methodologic scores (Oxford Levels of Evidence; Assessment of Multiple Systematic Reviews (AMSTAR); Quality of reporting of meta-analyses (QUROM); Oxman and Guyatt. After that, the Jadad decision algorithm was used to identify which studies in our sample contained the best available evidence. Finally, overlap of each systematic review was assessed using Corrected Covered Area (CCA) to look at redundancy and research waste among the systematic reviews published on the topic.ResultsAfter screening, 12 studies were included in our sample. For the Oxford Levels of Evidence, we found that all the studies were Level I evidence. For the QUORUM assessment, we had 1 study with the highest score of 18. Additionally, we did the Oxman and Guyatt assessment, where we found 4 studies with a maximum score of 6. Finally, we did an AMSTAR assessment and found 2 studies with a score of 9. After conducting the methodological scores; the authors determined that Li. L et al 2021 had the highest quality. In addition, it was found that the CCA found among the primary studies in each systematic review calculated to .22. Any CCA above .15 is considered "very high overlap".ConclusionsThe best available evidence suggests that Cemented HAs are better at preventing Prosthesis-related complications. Conversely, the best evidence also suggests that Cemented HA also results in longer operative time and increased intraoperative blood loss. When conducting future systematic reviews related to the topic, we ask that authors restrict conducting another systematic review until new evidence emerges so as not to confuse the clinical decision-making of physicians.

Project description:INTRODUCTION:Hip fracture is a serious injury in adults, especially those aged over 60 years. The most common type of hip fracture (displaced intracapsular) is treated for the majority of patients with a partial hip replacement (hemiarthroplasty). The hemiarthroplasty implant can be fixed to the bone with or without bone cement. Cement is the current recommended technique but recently some risks have been identified, which could potentially be avoided by using uncemented implants. Controversy, therefore, remains about which type of hemiarthroplasty offers patients the best outcomes.This is the protocol for a multicentre randomised controlled trial comparing cemented hemiarthroplasty versus uncemented hemiarthroplasty for patients 60 years and over with a displaced intracapsular hip fracture. METHODS AND ANALYSIS:Multicentre (a minimum of seven UK hospitals), multisurgeon, parallel group, two-arm, superiority, randomised controlled trial. Patients aged 60 years and older with a displaced intracapsular hip fracture treated with hemiarthroplasty surgery are eligible. Participants will be randomly allocated on a 1:1 basis to either a cemented hemiarthroplasty or a modern hydroxyapatite coated uncemented hemiarthroplasty. Otherwise all care will be in accordance with the National Institute for Health and Care Excellence guidance. A minimum of 1128 patients will be recruited to obtain 90% power to detect a 0.075-point difference in the primary endpoint: health-related quality of life (EuroQol 5 dimensions 5 levels) at 4?months postinjury. The treatment effect will be estimated using a two-sided t-test adjusted for age, gender and cognitive impairment based on an intention-to-treat analysis. Secondary outcomes include mortality, complications including revision surgery and cause, mobility status, residential status, health-related quality of life at 1 and 12?months and health resource use. A within-trial economic analysis will be conducted. ETHICS, DISSEMINATION AND FUNDING:Wales Research Ethics Committee 5 approved the feasibility phase on 2 December 2016 (16/WA/0351) and the definitive trial on 22 November 2017 (17/WA/0383). This study is sponsored by the University of Oxford and funded by the National Institute for Health Research, Research for Patient Benefit (PB-PG-0215-36043 and PB-PG-1216-20021). A manuscript for a peer-reviewed journal will be prepared and the results shared with patients via local mechanisms at participating centres. TRIAL REGISTRATION NUMBER:ISRCTN18393176.

Project description:ImportanceConsensus guidelines and systematic reviews have suggested that cemented fixation is more effective than uncemented fixation in hemiarthroplasty for displaced femoral neck fractures. Given that these recommendations are based on research performed outside the United States, it is uncertain whether these findings also reflect the US experience.ObjectiveTo compare the outcomes associated with cemented vs uncemented hemiarthroplasty in a large US integrated health care system.Design, setting, and participantsRetrospective cohort study of 12 491 patients aged 60 years and older who underwent hemiarthroplasty treatment of a hip fracture between 2009 and 2017 at 1 of the 36 hospitals owned by Kaiser Permanente, a large US health maintenance organization. Patients were followed up until membership termination, death, or the study end date of December 31, 2017.ExposuresHemiarthroplasty (prosthetic replacement of the femoral head) fixation via bony growth into a porous-coated implant (uncemented) or with cement.Main outcomes and measuresThe primary outcome measure was aseptic revision, defined as any reoperation performed after the index procedure involving exchange of the existing implant for reasons other than infection. Secondary outcomes were mortality (in-hospital, postdischarge, and overall), 90-day medical complications, 90-day emergency department visits, and 90-day unplanned readmissions.ResultsAmong 12 491 patients in the study cohort who underwent hemiarthroplasty for hip fracture (median age, 83 years; 8660 women [69.3%]), 6042 (48.4%) had undergone uncemented fixation and 6449 (51.6%) had undergone cemented fixation, and the median length of follow-up was 3.8 years. In the multivariable regression analysis controlling for confounders, uncemented fixation was associated with a significantly higher risk of aseptic revision (cumulative incidence at 1 year after operation, 3.0% vs 1.3%; absolute difference, 1.7% [95% CI, 1.1%-2.2%]; hazard ratio [HR], 1.77 [95% CI, 1.43-2.19]; P < .001). Of the 6 prespecified secondary end points, none showed a statistically significant difference between groups, including in-hospital mortality (1.7% for uncemented fixation vs 2.0% for cemented fixation; HR, 0.94 [95% CI, 0.73-1.21]; P = .61) and overall mortality (cumulative incidence at 1 year after operation: 20.0% for uncemented fixation vs 22.8% for cemented fixation; HR, 0.95 [95% CI, 0.90-1.01]; P = .08).Conclusions and relevanceAmong patients with hip fracture treated with hemiarthroplasty in a large US integrated health care system, uncemented fixation, compared with cemented fixation, was associated with a statistically significantly higher risk of aseptic revision. These findings suggest that US surgeons should consider cemented fixation in the hemiarthroplasty treatment of displaced femoral neck fractures in the absence of contraindications.

Project description:BackgroundSeveral factors might be associated with risk of dislocating following uncemented hemiarthroplasty (HA) due to femoral neck fracture (FNF). Current evidence is limited with great variance in reported incidence of dislocation (1-15%). Aim of this study was to identify the cumulative incidence of first-time dislocation following HA and to identify the associated risk factors.MethodWe performed a retrospective cohort study of patients receiving an HA (BFX Biomet stem, posterior approach) at Copenhagen University Hospital, Bispebjerg, in 2010-2016. Patients were followed until death or end of study (dec 2018). Dislocation was identified by code extraction from the Danish National Patient Registry. Variables included in the multivariate model were defined pre-analysis to include: age, sex and variables with a p-value < 0.1 in univariate analysis. A regression model was fitted for 90 days dislocation as the assumption of proportional hazard rate (HR) was not met here after.ResultsWe identified 772 stems (some patients occurred with both right and left hip) and 58 stems suffered 90 dislocations during the observation period, resulting in a 7% (CI 5-9) incidence of dislocation 90 days after index surgery. 55 of the 58 stems (95%) experienced the first dislocation within 90 days after surgery. Only absence of dementia was identified as an independent protective factor in the cause-specific model (HR 0.46 (CI 0.23-0.89)) resulting in a 2.4-fold cumulative risk of experiencing a dislocation in case of dementia. Several other variables such as age, sex, various medical conditions, surgery delay and surgical experience were eliminated as statistical risk factors. We found a decrease in survival probability for patients who experienced a dislocation during follow-up.ConclusionsThe incidence of first-time dislocation of HA (BFX Biomet stem, posterior approach) in patients with a hip fracture is found to be 7% 90 days after surgery. Due to the non-existing attribution bias, we claim it to be the true incidence. Dementia was among several variables identified as the only risk factor for dislocation. In perspective, we may consider treating patients with dementia by other methods than HA e.g., HA with cement or with a more constrained solution. Also, a surgical approach that reduce the risk of dislocation should be considered.

Dataset Information

Historically, did Cemented Thompson perform better than uncemented Austin Moore hemiarthroplasty for femoral neck fractures? A meta-analysis of available evidence.

Publications

Historically, did Cemented Thompson perform better than uncemented Austin Moore hemiarthroplasty for femoral neck fractures? A meta-analysis of available evidence.

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